Provider Demographics
NPI:1811956816
Name:BELL, THEDA DIANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:THEDA
Middle Name:DIANE
Last Name:BELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:105 SOUTH TATUM STREET
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-0434
Mailing Address - Country:US
Mailing Address - Phone:615-563-8501
Mailing Address - Fax:615-536-8501
Practice Address - Street 1:105 S TATUM ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1138
Practice Address - Country:US
Practice Address - Phone:615-563-8501
Practice Address - Fax:615-536-8501
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000036501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3927918Medicaid
TN3927918Medicaid